Jeb Riley Wild, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

65159 Issued in OR

Practice address

24076 SE Stark St Ste 200
Gresham, OR 97030-3376

Phone

(503) 491-1666

NPI assigned

Jan 10, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sportscare Physical Therapy @ Cornell, LLC

  • Physical Therapy Clinic/Center
  • Beaverton, OR
  • NPI 1649534793
  Medicare reassignment NPD
• Gateway Parkrose Sports Care PT LLC

  • Physical Therapy Clinic/Center
  • Portland, OR
  • NPI 1982748141
  NPD
• Sportscare Physical Therapy @ Cornell, LLC

  • Durable Medical Equipment & Medical Supplies
  • Tigard, OR
  • NPI 1255190153
  NPD
• Cascade Gresham Physical Therapy, Inc.

  • Specialist
  • Gresham, OR
  • NPI 1689657769
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1497526222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 SW COLUMBIA ST APT 1502",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972015887",
            "telephone_number": "772-971-1144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24076 SE STARK ST STE 200",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303376",
            "telephone_number": "503-491-1666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "JEB",
        "middle_name": "RILEY",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-10",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "65159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rodney Whiteside
• Brooke Whiting, LE
• Grace Whitty, CSWA
• Emily Wiessner
• Wild Earth Wellness
• Jordan William Wilde, D.C.
• Tiffany Wildes
• Wildflower Counseling Collective LLC
• Jessica Ann Wilkerson, APRN-NP
• Leah Leanne Wilkinson

• Physical Therapist in Gresham, OR
• Providers in Gresham, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.